Trial Court Pushes Back on “Fraud with Particularity” Requirement

Posted on January 25, 2017 in Rule 9(b)

The Federal District Court for the Middle District of Florida appears to have rejected recent direction from the Eleventh Circuit Court of Appeal to deny a motion to dismiss in a False Claims Act case. In United States ex rel. Napoli et al. v. Premier Hospitalists PL, et al. the... Continue Reading →

Tags: Clausen, False Claims Act, FCA, fraud, fraud with particularity, Jallali, Mastej, Napoli, Premier Hospitalists, Rule 9

OIG Final Rule Significantly Expands Exclusion Authority

Posted on January 19, 2017 in Exclusion

On January 12, 2017, the Department of Health and Human Services Office of Inspector General (“OIG”) published the “Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Exclusion Authorities” Final Rule (“Final Rule”) revising and expanding its authority to exclude individuals and entities from participation in... Continue Reading →

Tags: Abuse, ACA, Affirmative, Affordable Care Act, Authority, Changes, DOJ, Early reinstatement, Exclusion, Expand, False Claims Act, FCA, Final Rule, fraud, HHS, OIG, Permissive, regulation, Reinstatement, Revisions, update

Skilled Nursing Facility Chain Settles False Claims Act Case for $145 Million

Posted on November 3, 2016 in Settlement, Worthless Services

On October 24, the Department of Justice (“DOJ”) announced a $145 million False Claims Act settlement with a national skilled nursing facility provider that operates more than 200 skilled nursing facilities (the “Company”) and its individual owner. The settlement has been touted as the largest in the DOJ’s history with a skilled nursing facility... Continue Reading →

Tags: False Claims Act, FCA, nursing home, Skilled Nursing Facility, SNF

Seventh Circuit: Implied Certification Claims Remain a Heavy Lift

Posted on October 25, 2016 in Case Analysis, Conditions of Participation, False Certification

In light of the Supreme Court’s recent decision in Universal Health Services v. Escobar, the Seventh Circuit revisited its prior ruling in United States ex rel. Nelson v. Sanford-Brown, Ltd, a case alleging that a college receiving federal subsidies violated the False Claims Act (“FCA”) by maintaining discriminatory recruiting and... Continue Reading →

Tags: certification, Escobar, False Claims Act, FCA, implied

Court Strikes Allegations Whistleblower Learned Through Discovery and Dismisses Claims

Posted on October 21, 2016 in Discovery, Rule 12(b)(6)

In United States of America and the State of Florida, ex rel. Bingham v. HCA, Inc., the employee of a medical office building management firm filed suit against a national health care system in the U.S. District Court for the Southern District of Florida. The lawsuit included allegations relating to... Continue Reading →

Tags: discovery, False Claims Act, FCA, motion to dismiss

The Eighth Circuit Applies Escobar Materiality Test

Posted on October 20, 2016 in Materiality

The Eighth Circuit Court of Appeals yesterday applied the materiality standard enunciated by the Supreme Court in Universal Health Services, Inc. v. United States ex rel. Escobar to a False Claims Act (“FCA”) case alleging fraudulent inducement. In United States ex rel. Miller v. Weston Educational Inc., d/b/a Heritage College, two whistleblowers alleged Heritage College... Continue Reading →

Tags: Escobar, False Claims Act, Heritage College, materiality, Weston Educational

Seventh Circuit Says “Medical Necessity” FCA Claims Require Specifics

Posted on September 7, 2016 in Rule 9(b)

Last week, the Seventh Circuit Court of Appeals handed down its decision in US ex rel. Presser v. Acacia Mental Health Clinic, LLC. [1] The FCA case was brought by a nurse practitioner whistleblower who alleged that services being provided were not medically necessary. The court affirmed dismissal under Rule 9(b)... Continue Reading →

Tags: Acacia, False Claims Act, FCA, fraud with particularity, medical necessity, Presser, reasonable and necessary

Government Challenges “Materiality” Standard of Escobar

Posted on September 6, 2016 in False Certification, Government Intervention

Ever since the Supreme Court’s June 16, 2016 decision in Universal Health Services, Inc. v. United States ex rel. Escobar, a False Claims Act (“FCA”) case upholding the theory of implied certification, significant discussion has commenced regarding the Court’s “new” FCA materiality standard. How the appellate courts define materiality under... Continue Reading →

Tags: Escobar, false certification, False Claims Act, FCA, government, implied certification, Marsteller, material, materiality, Tilton, Universal Health Services

9th Circuit Issues Blockbuster Medicare Advantage FCA Decision

Posted on August 11, 2016 in False Certification, Rule 9(b)

The 9th Circuit Court of Appeals just issued a blockbuster ruling in U.S. ex rel. Swoben v United Healthcare et al., ruling that United Healthcare, WellPoint, Aetna and other major health insurance providers must answer to a whistleblower’s complaint that they defrauded the Medicare Advantage program. The Medicare Advantage Program,... Continue Reading →

Tags: certificaiton, False Claims Act, FCA, Medicare Advantage, Medicare Part C, Swoben, United Healthcare

Massive Penalty Spike Darkens the FCA Landscape

Posted on June 30, 2016 in Case Analysis, Damages, Statutes and Regulations

In November 2015, the Bipartisan Budget Act of 2015 went into effect. One aspect of that act was the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015. The new law required that the Program Fraud Civil Remedies Act and the False Claims Act (“FCA”) penalties be “corrected” to... Continue Reading →

Tags: adjustment, Department of Justice, False Claims Act, FCA, fines, government, inflation, maximum, minimum, penalties